| NPI | 1821637646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-19291) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P19283) |
| Enumeration Date | 2019-12-26 |
| Last Update Date | 2020-07-22 |